Recertification in internal medicine: a program of continuous professional development. Task Force on Recertification.

In 2000, the American Board of Internal Medicine (ABIM) introduced a second-generation recertification process that builds on the current knowledge-centered program by adding assessments of clinical and communication skills, clinical performance, and medical outcomes. The three-part process, called a program of continuous professional development, includes innovative self-evaluation exercises, documentation of essential knowledge, and confirmation of satisfactory qualifications and professional and community good standing. The program introduces the principles of continuous quality improvement; deemphasizes the summary nature of the traditional secure examination; and is designed to be a more continuous, less saltatory process for maintaining clinical competence. With the continuous professional development program, ABIM believes that it has taken a substantial step toward creating a recertification process that meets its goal of being valuable, doable, tolerable, and affordable" while maintaining the high standards expected of an accountable profession.

How to counsel patients about exercise: an office-friendly approach.

Despite the demands of a busy office setting, a brief physician counseling session about exercise can be highly effective and well worth the precious time. Components include delivering a clear message about exercise, stepping back to assess the patient's readiness to change, and using the patient's cues to set an activity agenda. Physician counseling about exercise is crucial to improving patients' health status and to the success of the several activity recommendations contained in the federal government's Healthy People 2010 report.

The U.S. model of internal medicine in and outside the hospital.

The most striking change of the U.S. model of internal medicine has been expansion beyond a hospital-based, disease-focused, diagnostic and therapeutic discipline to one that includes ambulatory care for the well and the sick, and the management of disease, resources and information. In 1987 the American Board of Internal Medicine's Task Force on the Future of Internal Medicine proposed that general internal medicine should evolve to the new manager of care. Moreover, it recommended that general internal medicine and its subspecialties should remain united as a single integrated discipline. The 1997 training requirements added the study on practice of health promotion and disease prevention. Over 60% of U.S. internists practice a subspecialty, many as consultants both in and outside the hospital. Patients encounter a variety of doctors' offices: one-third are the decreasing number of general practice offices, one-third are the growing number of family practice offices; and one-third are general internal medicine offices; all of them are primary care specialists. In 1999 the general internist is a "doctor for adults"; he or she retains the original role diagnostician for patients with difficult or undifferentiated problems and for patients who will ultimately receive care from a subspecialist. The new age internist is the manager. He or she manages sick patients with complex problems.

The University of Oklahoma College of Medicine Rural Health Educational Program.

Training of physicians to meet the health care needs of rural residents has long been a priority of the University of Oklahoma College of Medicine. With establishment of the much imitated Rural Preceptorship Program in 1948, the college launched an ongoing series of efforts all directed toward increasing the number of graduates choosing to practice in rural locations. In addition to the required senior Preceptorship Program, a series of educational programs is available in each year of medical school, actually beginning prior to freshman enrollment. As a result, the college now offers a comprehensive series of educational experiences involving not only four years of medical school, but graduate training in the primary care specialties as well. This report summarizes the various activities of the college that now make up the rural emphasis program, all of which are designed to help ensure an adequate supply of physicians for rural Oklahoma.

Medical student career choices--the University of Oklahoma College of Medicine experience, 1981-1990.

This is the second of several articles dealing with medical education and recruitment in Oklahoma and generated at the request of the OSMA-OUHSC Liaison Committee. The articles were sought out and submitted with the assistance of Edward N. Brandt, Jr., MD, PhD, executive dean of the University of Oklahoma College of Medicine.

Patient education in hypertension: five essential steps.

Greater medical education of patients requires individualized strategies with improved efficacy and effectiveness. We present a model for interactive patient education that has grown from our clinical work with patients who have multiple cardiovascular risk factors. The model distinguishes five stages in the process of a patient's health behavioural change (awareness, intention, trial, implementation and maintenance), and it links each stage with one of five different types of educational intervention (information exchange, negotiating readiness to change, building instrumental skills, developing coping behaviour and enhancing social support). The model provides the framework for a structured approach to more useful and efficient patient education which defines specific tasks and skills to be taught, learned and practised in a systematic and consistent manner.

Attitudes towards disability expressed by spouses of stroke patients.

A report is given on attitudes to disability expressed by spouses of patients disabled by cerebrovascular accident. In a sample of 79 spouses overprotection and unrealistic attitudes were a more common response than rejection or retributive guilt feelings. Attitudes of retributive guilt, rejection, unrealistic aims and overprotection in the spouse were not significantly related to the presence or absence of aphasia.

Psychosocial readjustment in the spouses of aphasic patients. A comparative Survey of 79 subjects.

The study set out to investigate readjustment to disability on the part of spouses of patients disabled by a cerebrovascular accident and to elicit the particular problems faced by the spouse of an aphasic patient. In a sample of 79 subjects, spouses of aphasic patients showed evidence of significantly poorer overall social adjustment then spouses of non-asphasic patients. The areas that were particularly impaired were social and leisure activities and marital relationships. In the marital area aphasia appeared to be particularly disruptive and the marriages were characterised by problems of interpersonal communication, diminished sexual satisfaction and loss of partnership. There was a raised incidence of minor psychiatric disorder in all spouses and again this was more pronounced amongst the spouses of aphasic patients.

Idiopathic pulmonary hemosiderosis. Electron microscopic, immunofluorescent, and iron kinetic studies.

The clinical course of a 37-year-old white man with idiopathic pulmonary hemosiderosis is presented. This patient is unusual in that he has had repeated exacerbations and remissions over a period of seven years and remains currently in spontaneous remission with no therapy. Routine sections of the lung biopsy revealed characteristec findings. Immunofluorescence staining of the lung was negative, and electron microscopic studies showed only nonspecific findings. While in remission, 51chromium-labelled red-blood-cell survival studies and 59iron kinetic studies were performed; the results were normal.